5 Ways US Medical Billing Is Way More F#@ked Than You Think

If you're not from America, or you're young and healthy enough to have avoided doctors up to now, you may not have been exposed to the delights of this country's high medical costs. So here's a demonstration, in the form of a $243K bill for a three-night hospital stay:

Hospital bills topping one million dollars are on the rise, and even a minor injury can leave you with a bill that looks like the hospital replaced all of your internal organs with diamond-studded plutonium. But beyond the initial punch to the wallet, the awfulness of ridiculous medical bills extends to places you might not have thought. Such as ...

#5. Even Insured People Are Going Bankrupt

The majority of bankruptcies in America are now caused by medical bills. Clearly, these bankruptees were devil-may-care hooligans who chose not to protect themselves with health insurance. Oh, wait: Most of them did have insurance. Three-quarters of Americans whose medical bills contributed to their bankruptcies were insured when their health problems began. Their real problem was that these un-American slackers were dumb enough to not be able to afford a low-deductible plan, or clumsy enough to come down with something that their insurance didn't cover.

And when you look at the random bills that even insured people get hit with, it's not hard to see how this can happen. I have a friend who broke an ankle slipping on her frozen driveway during the seven-month ice storm people in New York call a "winter." She was insured with an 80/20 plan, but still received a bill for around $6,000. This month, I got a letter from my own insurance company arguing that a single blood test I got back in March wasn't "medically necessary" and warning me that I might have to cough up the full price. How much was the full price of that single blood test? Just 5,000 freakin' dollars. Luckily nothing came of it, because otherwise I would have had to dip pretty deep into my weekly writer's salary.

Allan Danahar/Photodisc/Getty ImagesIt's so embarrassing when you're at the local writer's club and can't afford to tip the valet.

These incredibly high and apparently random medical costs get even more ridiculous when you consider that ...

#4. Stupid Frivolous Shit Actually Costs Us Less

These bills are high, but hey, maybe doctor stuff just costs a lot. Those long white coats and stethoscopes-around-the-neck don't pay for themselves! Except that while fixing a broken ankle apparently costs as much as a new car or two, the charge for laser eye surgery is usually only around $2,000 per eye. And this isn't a freak outlier: Nonessential procedures like cosmetic rhinoplasty often cost a lot less than surgeries that people actually need.

Why is essential medical care so much more expensive? Look at it like this: Say you're a plastic surgeon who performs extra-nipple implants. This procedure isn't considered medically necessary, and therefore is not covered by most insurance companies, meaning that your patients must pay you directly. If patients choose not to buy your extra nipples for $5,000 per nipple, you'll have to lower the price to $4,000, or else change your business model.

But when you add in the American system of mostly-employer-based health insurance, things get weird. The patient doesn't pay the doctor directly -- a lot of Americans don't even realize that this is an option. Instead, hospitals and medical practices bill the patient's insurance company. Because insurance companies are usually big and powerful enough to have bargaining power, there's a good chance that they will respond by farting on the bill and sending it back. Hospitals know this, and so over the years they've started making up their own extremely high prices and throwing them at insurance companies in the hope that they will pay something. These so-called "chargemaster" rates have grown so ludicrous over the years that they now include things like $37 Tylenol pills and $137 IV bags.

Once again, these chargemaster rates are mostly completely made up and have nothing to do with what these things actually cost. They're simply part of the monetary dance-off that insurance companies and hospitals are doing with one another. In most cases, the insurance companies agree to pay a small amount of the stupidly high bill, the hospital accepts this reduced amount, and everyone is happy. Except for uninsured and underinsured people, that is, because they are also billed at the chargemaster prices.

There are a bunch of other factors at work, of course, but this is a big reason why a single petting-zoo mishap could end up costing you the price of a small car. But most hospitals will still tell us that everything is fine for Joe Injured American, because ...

#3. Everyone Is in on the Con but You

When asked how people could be expected to pay chargemaster rates, the vice president of the American Hospital Association insisted that $37-Tylenol-style prices are not so bad, because they are "generally not what a consumer would pay." In other words, only suckers pay sticker price. Big medical bills are just a silly game between hospitals and insurers, and us consumers should just laugh it off for the same reason we laugh off the neighbors' late-night throwing-knife fights: It doesn't affect us, and it isn't our problem.

Let's pretend now that the American Hospital Association is telling the absolute truth. Let's pretend that all patients have to do is call and ask, and hospitals will slash the bill every time (and not just sometimes, as is really the case). Let's pretend that cancer patients have the time and money to dispute every single item on their $70,000 chemo bill while they are trying to concentrate on having the goddamn cancer. Let's pretend that people are really only at risk of medical bankruptcy if they break their leg 60 times in a row.

James Woodson/Digital Vision/Getty Images"Dammit! Again!"

We'll assume all that, and it still doesn't matter, because most people don't know that chargemaster rates are a joke. Do a quick survey of posts about medical bills on social media, and you won't find many stories of Americans receiving a letter, rolling up their sleeves, and marching down to the hospital to dispute the fuck out of some billing. Instead, most people receive bills and immediately start wondering how they can pay the whole thing off, whether it's by getting another job or asking for donations or by cooking meth or whatever.

Why are so many people unwittingly allowing themselves to be ripped off like this? Maybe it's because America is not a bargaining culture. Guidebooks written for Americans traveling overseas are full of warnings about not paying full price for traditional French penis statues or whatever: French penis-mongers, the books will tell you, quote high prices but expect to be haggled down. Maybe Americans need these warnings because in this country bargaining is generally something that happens only when you're dealing with professions seen as shady or dishonest, like car dealerships. Yet at some point doctors and hospitals, the people we trust with our family members' lives, have migrated into this same shady "don't trust the quoted price" category. And then we're surprised that some people don't realize this.